A Pilot Program Integrating Hepatitis B Virus (HBV) Screening into an Outpatient Endoscopy Unit Improves HBV Screening Among an Ethnically Diverse Safety-Net Hospital.

BACKGROUND: Safety-net hospitals are enriched in ethnic minorities and provide opportunities for high-impact hepatitis B virus (HBV) screening. AIM: We aim to evaluate the impact of a pilot program integrating HBV screening into outpatient endoscopy among urban safety-net populations. METHODS: From July 2015 to May 2017, consecutive adults undergoing outpatient endoscopy were prospectively assessed for HBV screening eligibility using US Preventative Services Task Force guidelines. Rates of prior HBV screening were assessed, and those eligible but not screened were offered HBV testing. Multivariate logistic regression models evaluated predictors of test acceptance among eligible patients. RESULTS: Among 1557 patients (47.1% male, 69.4% foreign born), 65.1% were eligible for HBV screening, among which 24.5% received prior screening. In our pilot screening program in the endoscopy unit, 91.4% (n = 855) of eligible patients accepted HBV testing. However, only 55.3% (n = 415) of those that accepted actually completed HBV testing. While there was a trend toward higher rates of test acceptance among African-Americans compared to non-Hispanic whites (OR 3.31, 95% CI 0.96-11.38, p = 0.06), no other sex-specific or race/ethnicity-specific disparities in HBV test acceptance were observed. Among those who completed HBV testing, we identified 10 new patients with chronic HBV (2.4% prevalence). Only 24.5% of eligible patients received prior HBV screening among our cohort. CONCLUSIONS: Our pilot program integrating HBV screening into outpatient endoscopy successfully tested an additional 415 patients, improving overall HBV screening from 24.5 to 75.6%. Integrating HBV testing into non-traditional settings has potential to bridge the gap in HBV screening among safety-net systems.

Medicaid and Uninsured Hepatocellular Carcinoma Patients Have More Advanced Tumor Stage and Are Less Likely to Receive Treatment.

GOALS: To evaluate the impact of insurance status on tumor stage at diagnosis, treatment received, and overall survival among adults with hepatocellular carcinoma (HCC). BACKGROUND: Insurance status affects access to care, which impacts timely access to cancer screening for early detection and treatment. STUDY: Using the 2007 to 2012 Surveillance, Epidemiology, and End Results (SEER) database, we retrospectively evaluated US adults with HCC. Insurance status included Medicare/commercial insurance (MC), Medicaid (MA), and no insurance (NI). HCC tumor stage was evaluated using SEER staging system and Milan criteria. HCC treatment and survival were evaluated using multivariate logistic regression and Cox proportional hazards models. RESULTS: Among 32,388 HCC patients (71.2% MC, 23.9% MA, and 4.9% NI), patients with MA or NI were significantly less likely to have localized tumor stage at time of diagnosis compared with MC [NI vs. MC; odds ratio, 0.41; 95% confidence interval (CI), 0.78-0.92; P<0.001]. MA and NI patients were less likely to receive treatment, and specifically less likely to receive surgical resection or liver transplantation compared with MC patients, even after correcting for tumor stage at diagnosis (odds of surgical resection or liver transplant in NI vs. MC: odds ratio, 0.26; 95% CI, 0.21-0.33; P<0.001). NI patients (hazard ratio, 1.39; 95% CI, 1.29-1.50; P<0.001) had significantly lower survival compared with MC patients. CONCLUSIONS: Among US adults with HCC, MA, or NI patients had more advanced tumor stage at diagnosis, lower rates treatment, and significantly lower overall survival. Ensuring equal insurance coverage may improve access to care and mitigate some disparities in HCC outcomes.

Black Patients with Colorectal Cancer Have More Advanced Cancer Stage at Time of Diagnosis: A Community-Based Safety-Net Hospital Experience.

Colorectal cancer (CRC) remains a leading cause of morbidity and mortality in the U.S. Disparities in access to care contribute to advanced CRC stage at diagnosis, and these disparities are most pronounced among underserved populations and ethnic minorities. We aim to evaluate race/ethnicity-specific disparities in CRC stage at diagnosis among an ethnically diverse, urban safety-net hospital. We retrospectively evaluated all adult CRC patients diagnosed from January 1, 2009 to October 1, 2015. CRC cases were confirmed by histopathology specimens from biopsies and/or surgical resection. CRC staging utilized American Joint Committee on Cancer (AJCC) staging systems and were stratified by race/ethnicity. Multivariate logistic regression models were utilized to evaluate disparities in AJCC stage at presentation (stage 3-4 vs. stage 0-2). Among 311 patients with CRC [51.5% male, 25.3% black, 18.7% Hispanic, 32.0% Asian, and mean age at diagnosis 58.1 years (SD 10.3)] 61.4% had advanced ACC stage 3-4 CRC at diagnosis. Among black patients with CRC, 73.3% had AJCC stage 3-4 cancer at time of diagnosis. On multivariate regression, blacks were nearly four times more likely to have advanced AJCC stage 3-4 CRC at diagnosis compared to whites (OR 3.70; 95% CI 0.97-14.11; p = 0.055). Among a diverse underserved population, over 60% of CRC were AJCC stage 3-4 at diagnosis, and nearly 75% of blacks with CRC had AJCC stage 3-4 at diagnosis. Advanced stage CRC at diagnosis limits options for potentially curative therapies, and increases the risk for cancer recurrence and mortality.

Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy.

PURPOSE: Intraoperative optical biopsy technologies may aid in the identification of important anatomical landmarks and improve surgical outcomes of robotic assisted radical prostatectomy. We evaluate the feasibility of confocal laser endomicroscopy during robotic assisted radical prostatectomy. MATERIALS AND METHODS: A total of 21 patients with biopsy proven prostate cancer scheduled for robotic assisted radical prostatectomy were recruited. After intravenous administration of fluorescein 15 patients underwent in vivo intraoperative confocal laser endomicroscopy of prostatic and periprostatic structures using a 2.6 or 0.85 mm imaging probe. Standard robotic instruments were used to grasp and maneuver the confocal laser endomicroscopy probes for image acquisition. Confocal laser endomicroscopy imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions. RESULTS: Confocal laser endomicroscopy was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative confocal laser endomicroscopy imaging of the neurovascular bundle before and after nerve sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated normal prostate glands, stroma and prostatic carcinoma. CONCLUSIONS: We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during robotic assisted radical prostatectomy. Image guidance and tissue interrogation using confocal laser endomicroscopy offer a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery.

Emerging endoscopic imaging technologies for bladder cancer detection.

Modern urologic endoscopy is the result of continuous innovations since the early nineteenth century. White-light cystoscopy is the primary strategy for identification, resection, and local staging of bladder cancer. While highly effective, white light cystoscopy has several well-recognized shortcomings. Recent advances in optical imaging technologies and device miniaturization hold the potential to improve bladder cancer diagnosis and resection. Photodynamic diagnosis and narrow band imaging are the first to enter the clinical arena. Confocal laser endomicroscopy, optical coherence tomography, Raman spectroscopy, UV autofluorescence, and others have shown promising clinical and pre-clinical feasibility. We review their mechanisms of action, highlight their respective advantages, and propose future directions.

Violencia en el trabajo: perspectivas y desafios actuales / Violence at work: perspectives and current challenges / Violência no trabalho: perspectivas atuais e desafios

El trabajo recupera reflexiones en torno al fenómeno de la violencia y como ella se va incorporando al dia a dia de la sociedad. La estructura está en tres ejes: a) La violencia en el cotidiano; b) La violencia en las organizaciones; y c) la auto violencia. La idea es compartir vivencias para un escenario latinoamericano en donde la vida es dominada, después de la familia, por el orgullo de poseer al menos un trabajo. Este al ser escaso, se convierte en un valor y en un indicador futuro de progreso y estabilidad familiar, se vuelve en un objeto de deseo para quien lo posee. En esta idea, el trabajo es donde se convive con el sadomasoquismo cotidiano, con ataduras, sabotajes y tormentos, porque es en el donde se fundamentan las relaciones de poder y las jerarquías. Así, una persona tiene poder y autoridad sobre otra y puede abusar de ese poder y autoridad en cualquier forma o puede descargar frustraciones personales o profesionales. Todo ello alimentado por un contexto histórico permeado por la cultura que va imponiendo costumbres y valores, creando una antropología del sujeto y permitiendo o haciendo natural que se viva de esta manera. La reflexión desciende sobre el contexto mexicano y sobre una reflexión autocrítica de la cultura y la comunicación histórica vigente.

The work collects reflections regarding the violence phenomenon and how it becomes part of everyday society. It is structured in three different parts: a) Everyday violence; b) Violence in organizations; and c) Self-violence. The idea is to share experiences from a Latin-American scenario where life is dominated, after the family, by the pride in having, at least, a job. As jobs are scarce, employment becomes a value and an indicator of future progress and family stability; it also turns into an object of desire for those who possess it. In this sense, work is where one coexists with daily sadomasochism, with bondage, sabotage, and torment, because this is where the relations of power and hierarchy are based. Thus, a person has power and authority over another and can abuse that power and authority in various ways, or can even unload personal or professional frustrations. All of this is localized in an historical context by a culture that imposes customs and values, creating an anthropology of the subject, and allowing or making it natural to live in such a manner. This reflection descends on the Mexican context and on a self-criticism of the culture and the enforced historical communication.

O objetivo do artigo é refletir sobre o fenômeno da violência e como ela vem se incorporando no dia a dia da sociedade. O artigo está estruturado em três partes: a) a violência no cotidiano; b) a violência nas organizações; e c) a autoviolência. O objetivo é compartilhar vivências sobre um cenário latino-americano onde a vida é dominada, depois da família, pelo orgulho de se ter um trabalho. Por ser escasso, o trabalho se converte em um valor e também é um indicador de progresso futuro e estabilidade familiar, convertendo-se em um objeto de desejo. É no trabalho, no entanto, que se convive com o sadomasoquismo cotidiano, com as ataduras, sabotagens e tormentos, porque aí se encontram as bases das relações de poder e de hierarquia. Uma pessoa tem poder e autoridade sobre outra e pode abusar desse poder e autoridade em suas diversas formas ou ainda descarregar frustrações pessoais ou profissionais. Tudo isto circunscrito a um contexto histórico e cultural que impõe costumes e valores, e cria as bases de uma antropologia humana que naturaliza este modo de vida. A reflexão versa sobre o contexto mexicano fazendo uma autocrítica da cultura e da comunicação histórica vigente.

Violencia en el trabajo: perspectivas y desafios actuales / Violence at work: perspectives and current challenges / Violência no trabalho: perspectivas atuais e desafios

El trabajo recupera reflexiones en torno al fenómeno de la violencia y como ella se va incorporando al dia a dia de la sociedad. La estructura está en tres ejes: a) La violencia en el cotidiano; b) La violencia en las organizaciones; y c) la auto violencia. La idea es compartir vivencias para un escenario latinoamericano en donde la vida es dominada, después de la familia, por el orgullo de poseer al menos un trabajo. Este al ser escaso, se convierte en un valor y en un indicador futuro de progreso y estabilidad familiar, se vuelve en un objeto de deseo para quien lo posee. En esta idea, el trabajo es donde se convive con el sadomasoquismo cotidiano, con ataduras, sabotajes y tormentos, porque es en el donde se fundamentan las relaciones de poder y las jerarquías. Así, una persona tiene poder y autoridad sobre otra y puede abusar de ese poder y autoridad en cualquier forma o puede descargar frustraciones personales o profesionales. Todo ello alimentado por un contexto histórico permeado por la cultura que va imponiendo costumbres y valores, creando una antropología del sujeto y permitiendo o haciendo natural que se viva de esta manera. La reflexión desciende sobre el contexto mexicano y sobre una reflexión autocrítica de la cultura y la comunicación histórica vigente. (AU)

The work collects reflections regarding the violence phenomenon and how it becomes part of everyday society. It is structured in three different parts: a) Everyday violence; b) Violence in organizations; and c) Self-violence. The idea is to share experiences from a Latin-American scenario where life is dominated, after the family, by the pride in having, at least, a job. As jobs are scarce, employment becomes a value and an indicator of future progress and family stability; it also turns into an object of desire for those who possess it. In this sense, work is where one coexists with daily sadomasochism, with bondage, sabotage, and torment, because this is where the relations of power and hierarchy are based. Thus, a person has power and authority over another and can abuse that power and authority in various ways, or can even unload personal or professional frustrations. All of this is localized in an historical context by a culture that imposes customs and values, creating an anthropology of the subject, and allowing or making it natural to live in such a manner. This reflection descends on the Mexican context and on a self-criticism of the culture and the enforced historical communication.(AU)

O objetivo do artigo é refletir sobre o fenômeno da violência e como ela vem se incorporando no dia a dia da sociedade. O artigo está estruturado em três partes: a) a violência no cotidiano; b) a violência nas organizações; e c) a autoviolência. O objetivo é compartilhar vivências sobre um cenário latino-americano onde a vida é dominada, depois da família, pelo orgulho de se ter um trabalho. Por ser escasso, o trabalho se converte em um valor e também é um indicador de progresso futuro e estabilidade familiar, convertendo-se em um objeto de desejo. É no trabalho, no entanto, que se convive com o sadomasoquismo cotidiano, com as ataduras, sabotagens e tormentos, porque aí se encontram as bases das relações de poder e de hierarquia. Uma pessoa tem poder e autoridade sobre outra e pode abusar desse poder e autoridade em suas diversas formas ou ainda descarregar frustrações pessoais ou profissionais. Tudo isto circunscrito a um contexto histórico e cultural que impõe costumes e valores, e cria as bases de uma antropologia humana que naturaliza este modo de vida. A reflexão versa sobre o contexto mexicano fazendo uma autocrítica da cultura e da comunicação histórica vigente.(AU)